Missing Receipt Form FY
Use this form when a receipt has been lost or was never available. This form, when completed and signed (if applicable),
functions as your receipt. Attach to other forms and systems as needed.
Employee or Cardholder Name ____________________________________________________________________
Purchase Type:
Messiah College Card (M&T)
Requisition/Purchase Order
Personal Cash/Personal Credit Card
Other Reason: __________________________________________________________________________
What was
Where was the
purchase made?
Why was the
purchase made?
**Note: All expenditures must meet the criteria outlined in the Expenditure Policy in order to be paid using College Funds.
I certify that I have examined this request and that all expenses meet those outlined in Messiah College’s Expenditure Policy and
Purchasing Policies.
Employee/Cardholder _____________________________________________________________________________________
Printed Name Signature Date
Printed Name Signature Date
****Supervisor/VP signature not required if uploading Missing Receipt form to IntelliLink or MCOne$ource****
PO Number (if applicable)
Organization (Org #)
Account (Acct #)
Activity Code (if applicable)
Reason for Missing Receipt:
Receipt has been lost
Receipt was never provided
Other (please provide explanation below)
Purchase Amount _______________________________
Purchase Date _______________________________